Stiffness, aching joints and eczema aggravated by salicylates in heat rubs for joint pain One-liners Bernard's arthritis story Aching joints began during pregnancy Joint pain from intolerance to soy 'Awful joint pains' from salicylates in 'loads of fruit and veg'

Arthritis is rare in cultures that eat traditional diets based on grains and vegetables (1,2 see references below).

Arthritis is now the leading cause of disability in the United States - home of the Western diet – with on average about 30% of adults affected, and up to 38% in West Virginia (3).

Medications were the traditional treatment for arthritis. Drugs can work well in the short term but can have serious long term consequences and are no longer recommended for long term use (4).

Non drug strategies to manage arthritis, such as exercise and healthy lifestyle, are now officially recommended by the US Centers for Disease Control (5).

Fasting has been found to be an effective treatment for rheumatoid arthritis but most patients relapse on the reintroduction of food. This would appear to confirm the food connection. Vegetarian diets have been shown to help some people with arthritis (6,7).

In 1975, when highly processed foods were becoming common, American allergist Dr Ben Feingold was one of the first to recognise that the side-effects of food additives included arthralgia with edema (joint pain with swelling). He also recognised that people who are affected by additives can affected by natural chemicals called salicylates in varying amounts in plant foods including most fruit, some vegetables, herbs and spices (8).

The RPAH elimination diet (9) that we support is an improved version of Dr Feingold’s diet that helps with joint pain. Our database includes over 30 reports from people whose sometimes severe and crippling joint pain or arthritis symptoms – from osteoarthritis to juvenile rheumatoid arthritis – has been dramatically helped by diet., e.g.

"My daughter was diagnosed with juvenile arthritis when she was three. By the time she went to school, at five, she was crippled with it. She's now 25. Three weeks after she started her elimination diet, she told me: "Mum, the pain's gone. For the first time in 23 years, I have no pain".

In the medical journals, there are few conclusive studies regarding diet and joint pain. The Adventist Health Studies in the US found that greater meat consumption was associated with a higher prevalence of degenerative arthritis (10). In a large UK study, people with the highest red meat intake were found to have an increased risk for inflammatory polyarthritis (11). In 2017, an Australian rat study found that long term consumption of saturated fats in animal fats, butter, and palm oil could weaken the cartilage particularly in the weight-bearing joints of the hip and knee. “Our findings suggest that it’s not wear and tear but diet that has a lot to do with the onset of osteoarthritis”, said Professor Yin Xiao from Queensland University of Technology (12).

Also in 2017, a Canadian study found that the Western diet is associated with a higher risk of gout compared to the DASH "healthy" diet (lower meat, fat, sugar, salt, processed foods). Gout is the most common inflammatory arthritis and is increasing. See Sue's detailed gout blog post.

In 2002, an American study followed 24 people with moderate to severe arthritis on a very low-fat vegan diet free of processed foods and modelled on traditional diets. Lead researcher Dr John McDougall said “About 70% of people with rheumatoid arthritis (the most common form of inflammatory arthritis) can expect dramatic benefits, and often a cure, in less than 4 weeks of diet change” (13).

So which foods cause arthritis?

It seems clear that arthritic joint pain is related to components of the Western diet. But which ones? Everyone is different so it seems likely that problems vary - from dietary fats to additives in processed foods to natural food chemicals in "healthy" foods.

The McDougall diet avoids all animal foods and added fats, and therefore, most processed foods - but can be very high in salicylates, amines and glutamates, depending on food choices.

The RPAH elimination diet avoids additives and natural food chemicals (salicylates, amines and glutamates) and avoids most high fat processed foods but is higher in fats than the McDougall diet.

The McDougall diet works for 70% of people. Perhaps the other 30% need to avoid salicylates? Coincidentally or not, in our reports so far, about 30% (11 out of 34) of people are salicylate responders.

Reports from our database

As with other food intolerance symptoms, people are different, and most people are affected by more than one food chemical:

Most people reported that they improved on the RPAH diet, and were not sure which components affect them, or noticed that they were affected by “processed foods”

For the two vegans in this group (stories [1446] and [1400]), one needs to avoid additives in processed foods and the other needed to avoid salicylates and amines, so the McDougall vegan diet would have worked for one but not the other.What you can do

If you want to do a scientific investigation of the foods causing your arthritis pain, don’t expect your healthcare provider to help. If they recommend diet at all, it will probably be a “healthy” diet to lose weight. You will have to decide for yourself. There are two options.

1. RPAH elimination diet

We recommend a 3-4 week trial of the RPAH (Royal Prince Alfred Hospital) elimination diet with challenges for 2 reasons:

- this is the most comprehensive elimination diet, avoiding all foods and natural food chemicals likely to be a problem- the excellent RPAH challenges are a scientific way to pinpoint exactly what your problems are

The RPAH diet consists of 3 stages – elimination, challenges, reintroduction - to find out exactly which food chemicals are causing problems. For 3-4 weeks you have to avoid gluten, dairy foods, natural salicylates, amines and glutamates, and 50 additives, best done under the supervision of a dietitian because it can be complicated, especially challenges. It is important to see a dietitian with special training and interest in the RPAH diet, see our list below.

Note that some people may need longer on the diet and challenges – see Bernard’s arthritis story. it took him 8 days to react to the salicylate challenge, which normally finishes after 1 week – so it seems that for arthritis, reaction times may be slower.

Dietitians say that it cuts an hour off consultation times if patients have read my book Fed Up before they start – you don’t have to buy, it is usually available in libraries.

2. McDougall program

If you would like to avoid processed foods and stick to a healthy low fat vegan diet – eating loads of fruit and vegetables instead of meat and other animal products – you could consider the McDougall program. You have a 70% chance of reducing your arthritis symptoms within 4 weeks. Your risk of heart disease, cancer, dementia and obesity will be reduced too. You won’t know which components of your current diet were causing the problem, or maybe you will discover the culprits by breaking your diet occasionally. Dr McDougall recommends that arthritics start with his diet and progress to an elimination diet if no improvement within two weeks. (We do not recommend his "elimination diet" as it is high in salicylates). If the McDougall diet doesn’t work for you, consider salicylate sensitivity, and you can try the RPAH elimination diet.

It's a personal choice. In my experience, most people find the RPAH elimination diet easier to try first unless they are already vegetarian. Most people who contact us are not ready to become very low fat vegans. If there is little or no improvement it is possible to go on a fairly low fat version of the RPAH elimination diet, see Rosemaree's story [1404] Or you can progress to the McDougall diet if you would like to. Given the results of the Australian rat study in 2017 (above) that found long term consumption of saturated fats in animal fats, butter, and palm oil could weaken the cartilage particularly in the weight-bearing joints of the hip and knee (“not wear and tear but diet that has a lot to do with the onset of osteoarthritis") it seems worth a try. It is also possible to do a failsafe version of the McDougall diet, ask for our failsafe vegetarian/vegan hints ( This email address is being protected from spambots. You need JavaScript enabled to view it. )

Gluten free?

Dr McDougall recommends avoiding wheat for the first week then switching to gluten free. We usually recommend something similar – keep wheat in for the first week then go gluten free unless you’ve seen a huge improvement. This makes the diet changes easier to implement.

Q. I’m a vegetarian. Is it possible to combine both diets – an additive free, low salicylate, low amine, low glutamate version of the McDougall program?A. Yes, it is. Please request Sue’s failsafe vegetarian/vegan hints: This email address is being protected from spambots. You need JavaScript enabled to view it.

Some common myths about diet and arthritis

Like many myths, they are half right.

People with arthritis have to avoid high acid foods like tomatoes or oranges.

Tomatoes and oranges are very high in salicylates, amines and glutamates. It is true that they can contribute to arthritis in some people but not every arthritic has to avoid them. A systematic trial of the RPAH elimination diet can pinpoint dietary triggers for each individual.

People with arthritis have to avoid all the foods in the nightshade family (tomato, sweet pepper, eggplant, potato).

Tomatoes, capsicums and eggplants are all very high in salicylates, amines and glutamates so can contribute to arthritis in some people . Some varieties of potato (with white flesh and white or brown skin, large, old and thickly peeled) are low in these food chemicals and thus may be suitable for sensitive arthritics.

People with arthritis should avoid wheat and/or gluten.

It is true that wheat and/or gluten may contribute to arthritis in some people but not every arthritic has to avoid them. A systematic trial of the RPAH elimination diet can pinpoint dietary triggers for each individual.

Salicylates in medication can also cause problems

Paradoxically, many medications used for joint pain contain salicylates that can make arthritis worse in a salicylate-sensitive person. Aspirin and other Non Steroidal Anti-Inflammatory Drugs (NSAIDS) should be avoided on a low salicylate diet. Salicylates are easily absorbed through the skin so over-the-counter topical medications - such as lotions and ointments - can also cause problems. Some NSAIDS such as ibuprofen (Nurofen), naproxen and diclofenac do not contain salicylates but can affect salicylate-sensitive people with cross-reactivity problems. See first reader report below.

We solved my father in law's severe eczema after visiting your website. Dermatologist couldn't cure his problem at all, and he was using Wintergreen and Deep Heat to relieve the joint pain symptoms. Since following the low salicylate diet, he is 100%. He cannot believe that the stiffness and aching joints, and the bad eczema have disappeared. - Annelize, NSW

One-liners

My husband has severe and crippling arthritis - failsafe foods have given him relief and mobility. – by email, NZ [368] March 2005

I have osteo-arthritis which is much less painful if I adhere to the diet – if I inadvertently eat something that upsets me, I become overwhelmingly weary, my arthritis flares up and I can get bloating and irritable bowel symptoms. l often say in jest, " I cheat! I pay!" – by email, ACT [368] March 2005

My daughter was diagnosed with juvenile arthritis when she was three. By the time she went to school, at five, she was crippled with it. She's now 25. Three weeks after she started her elimination diet, she told me: "Mum, the pain's gone. For the first time in 23 years, I have no pain". - by email, NT [600] February 2008

My mother, grandmother and aunt all have arthritis. I've been failsafe for six years and I'm pretty sure if I wasn't failsafe I would have arthitis too, because I can notice my hands get stiff if I break my diet and eat too many salicylates. - by email, NT[600] February 2008

My 8 year old daughter has rheumatoid arthritis. It's hard to believe, after three weeks on failsafe foods, she is free of pain for the first time in years. - by email, NT [600] February 2008

I had quite marked arthritis until about 18 months ago when I stopped eating gluten and most grains/pseudo grains - it largely went away but more recently has started to happen again so I know that diet can work. The dietician is less than enthusiastic. – by email, WA

[601] Bernard's arthritis story (February 2008)

The most remarkable story comes from Bernard in Wollongong. Now active and virtually arthritis-free, Bernard suffered from painful and crippling arthritis for nearly 30 years. In 1994, he was told that if his arthritis was not controlled by daily use of medication, he had 'only four or five years of active life left'. After extensive reading, Bernard opted to try an elimination diet against the recommendation of his specialist, and achieved remarkable results. He warns that arthritis sufferers may need extra time. Bernard wrote:

'If you think that the time span of the food effects on children and their behaviour is long you should try solving the rheumatic and inflammatory disease problem. You are looking at an abstinence time of up to 12 weeks before challenges, symptoms that could take more than a week to identify, and challenges that could take four months or more to complete. I am still improving after eight and a half years on low chemical foods. NOTHING will make me eat the foods I once loved so much.' ...

When Bernard challenged salicylates, on the morning of the eighth day he found his arthritis had returned with such a vengeance that it took him an hour to get out of bed. Artificial food colouring took two days to aggravate his arthritis.

After so many years of needless pain and suffering it is not surprising that Bernard and others like him feel angry about misinformation from experts. When a well-known Australian nutritionist wrote that there is no truth in the rumour that people with arthritis should not eat tomatoes, Bernard added his own comment: 'like hell there isn't!'

You can read about the effects of additives and natural chemicals in fruit and vegetables in Bernard's "My life with arthritis" story: "I have suffered with the pain and swelling of arthritis in my arms, hands, neck, back, legs and feet for almost half of my adult life. At times my condition was so bad that I was only able to walk about 50 metres without a rest. The constant pain I suffered was unbearable ... " see this entire amazing story.

[602] Aching joints began during pregnancy (February 2008)

I began the elimination diet after reading Fed Up with Asthma [now out of print, the asthma information from this book has been incorporated into the 2008 edition of Fed Up]. I was pregnant with our second child. My first pregnancy was fraught with pain from aching joints, hips especially, from which I d never suffered before. The pain was very great and continued after childbirth, though not troubling me much, just now and then. My joint movement continued to be impaired. In this pregnancy the pain began in the first trimester, whereas it had begun late in the previous pregnancy. I suffered much sleeplessness and worried how I would last 9 months like this. After 2-3 weeks on the diet (dairy and gluten-free as well) I no longer needed ventolin at all, just one puff daily of my preventer (I'd been using ventolin up to 8 times daily with little effect and 4 puffs of the preventer). Also, no joint pain at all, and the return of a normal range of joint motion. - Elizabeth, by email

[603] Arthritis started after a car accident (February 2008)

My arthritis started after a car accident at the age of 19, also ringing in the ears. The arthritis was to the point where I would soak my hands in hot water each morning to get them ok to work. Both my arthritis and ringing in the ears disappeared totally on failsafe, it was incredible. Four years on, it remains largely stable, is clearly affected by mainly salicylates and sulphites and to a lesser extent amines and MSG. Medication was generally ineffective. - by email, Qld

[605] Joint pain from intolerance to soy (February 2008)

I am soy intolerant. More specifically I suffer from a legume intolerance which is only now apparent after 13 years of suffering and frustration. My intolerance manifests itself in the form of hives, large red itchy welts that, in a severe attack can cover almost all of the body, be unbelievably itchy and uncomfortable to say the least. In my situation, my symptoms got worst and extended to lethargy, aching and swollen joints, sleepless nights and eventually an emotional feeling of hopelessness of ever being able to stop the relentless onslaught. See the rest of this story on the website - story [314]: "13 years of intolerance to soy"

From the age of 15 I slowly became more and more tired and foggy headed. Gradually I found it impossible to walk to school anymore, and regularly got 12 hours of sleep or more a night. I found out a few years ago that gluten does awful things to my energy levels and brain function, I wish I had known that when I was at school as I'm sure it held me back. In the last two months I was put on a rotation diet where I had to eat a huge variety of fruit and vegetables but could only have each every fifth day. I have NEVER felt so foggy headed, had such blurry vision or had such awful joint pains. All from eating loads of fruit and veg. Consequently, I have high hopes for Failsafe!

I have rheumatoid arthritis, back damage and nerve issues and since eating primarily FS (ds is the one who NEEDs it --we just support and benefit too lol) I have less nerve problems , my joints and back pain is less and I have less flair ups! particularly since going low grain/gluten and I am worst if I overdo the gluten and processed foods! - from the facebook group

[1306] Juvenile arthritis: “Since I make all my own now, no pain” (February 2015)

I have juvenile arthritis for as long as I can remember, I have been completely pain free since February last year - I knew it was carrots, did not realisewhat's in stock powder and lots of other places. Since I make all my own now, no pain. I can now tolerate occasional infringements, just not regularly eating it - but I can also move freely - from the facebook group

[1307] Arthritis due to Chikungunya from Vanuatu holiday (February 2015)

My wife and I went for a 5 day holiday in Vanuatu. A few weeks after we came back I felt terrible, I could hardly get out of bed. I went to the doctor and said “I’ve been poisoned”. He did all the tests for Ross River fever etc but they came back negative. I had these awful pains in my joints, I couldn’t walk, I couldn’t open doors, anything. I was diagnosed with arthritis and took medication for 2 years. Then it all went away. Turns out I had chikungunya. The doctor didn’t test for that, I think it’s too new. - NSW

(Sue’s comment: polyarthritis - pain in 5 joints or more - can be associated with mosquito-borne diseases such as Ross River Fever, Barmah Forest Fever, Dengue Fever and Chikungunya . These diseases run a course of weeks or months but the joint pain can last for months or years and can be misdiagnosed as other types of arthritis, particularly with Chikungunya that is not yet routinely tested for but is now increasing in Asia and the Pacific Islands, and even in Europe).

SUCCESS!!! Our 12 year old daughter with Juvenile Rheumatoid Arthritis is pain free!!

We have finished all challenges on the elimination diet and have discovered glutamates - MSG and all 600 numbers to be extremely bad for our daughter with arthritis. Within 8 to 12 hours of having MSG our daughter went from no pain to all the symptoms of arthritis, swollen joints, very sore, trouble walking, and lots of pain. We continued the challenge for 48 hours and by then she had problems with all her joints, soreness, swelling and was absolutely miserable! Within 12 hours of stopping MSG her symptoms settled and she was back to "normal" – no pain! We now totally avoid MSG, all 600 numbers and unspecified 'flavour' listed on any product!

It has been 7 months now since we began the elimination diet and took our daughter off all arthritis medication. She is fantastic! We had a check up with the rheumatologist recently and she was amazed. We don't need to see her for another 6 months and she has classed our daughter as "in remission"!!!! No pain, No symptoms and No medication!

I hope this is of assistance to other sufferers of arthritis! It has made a huge difference to our daughter's life. Thank you for your wonderful information, without this we would be further down the track of a life of pain, misery and medications with nasty side effects for our daughter. To look at our daughter now, you would never know that she suffers from a chronic, debilitating condition, she is full of energy and her love for life is back again!

We completed all food challenges in this order: milk, wheat, bread, salicylates, amines, MSG, propionates, sorbates, antioxidants, colours, benzoates, nitrites and sulphites (all food not capsules). The only challenge our daughter reacted to was MSG, 600 numbers and naturally occurring glutamates. She had no reaction to any other challenge. Once we had completed all the challenges we challenged tomatoes, broccoli and those foods high in natural glutamates separately. She came out in an itchy rash if she ate too many tomatoes or broccoli (at least 6 to 8 serves a day) but the amazing thing for us was that she didn't have joint pains. We are tending to think that manufactured MSG must contain VERY HIGH levels of glutamic salt compared to those foods that have it naturally occurring such as tomatoes and broccoli. We have now restricted how much she has of these things. She is very good at knowing what she can and can't have. She reads labels everywhere, even when she stays over at friends or goes to birthday parties, she will read labels and decide if she can have it or not. We always send her with plain chips and 'safe' snacks for a party. Her friends have been very supportive and know that she can have plain hot chips at a party instead of pizza or party pies.

We saw the dietitian you recommended. She was very helpful, knowledgeable and thorough in what quantities etc to challenge. She was very interested in the results. She suspected MSG from early on because we had commented on how over the Christmas holidays (before elimination diet), our daughter had eaten CC's and was so sore the next day she could hardly walk. We kept a daily food diary and I also kept a dated scrap book with labels of products we had eaten so I could check back as a reference if needed.

For the MSG challenges we used "Coles Farmland" packet chicken noodle soup, about 500 mls to a litre a day (contains 621, 627 and 631) and soy sauce about 4+ tablespoons a day. (Need to check labels for soy sauce because not all list MSG or 600 numbers).

We are amazed at how many foods with unspecified 'flavour' (but no MSG or 600 numbers listed) affect her. We have found this with tomato soups, tomato pastes etc where they list 'flavour' and our daughter has been sore after having this. We have completed our own challenge with some of these products and her reaction varies. We avoid any savoury type products that have 'flavour' listed with no specific ingredient numbers on labels. The unknown is not worth the soreness for our daughter.

Foods previously eaten which we avoid completely now include: All packet soups, cup of soups, packet stocks, stock cubes, any chips or corn chips that have a flavour, BBQ shapes and all shape/savoury biscuits with flavour, tomato and BBQ sauce, some mayonnaise and dressings, packet pasta mixes (ie continental pasta packs), sausage rolls, pies, breads with savoury toppings, pizza, concentrated tomato paste, tomato soup - most have unspecified 'flavour' - and lots of other savoury foods. We never used to eat a lot of these foods, but even having things once to twice a week was enough to have our daughter in continuous pain.

She now is totally pain free, medication free and living a very active, sporting life. She plays netball weekly, has participated in the school athletics and cross country team this year and is currently in weekly training with the school volley ball team to go to Nationals in December. All of these activities were completely impossible 12 months ago! The difference is amazing! We are so thankful that your website and information has led us to finding an alternative to medication, and a way to manage our daughter's condition and allow her to live a very active life. I hope that there will be others out there that will try the elimination diet and find an alternative to medications and a life of chronic pain. - Sandra, Vic

[846] Pain like gout from milk (August 2009)

I have written before about my husband drinking milk and getting a pain like Gout in his foot. Now we just have A2 milk but he had a coffee one morning with Woolies Lite Milk (that’s all he could get and left the A2 for the kids) still got a pain in his foot, next time tried with A2 and didn’t have any pain. Tracey, by email (The medical recommendation for gout used to be avoidance of purine-containing foods - essentially failsafe foods with a few exceptions - but this has been disproved. I wonder whether gout is just another symptom of food intolerance because failsafe families often report the father’s gout improved when they changed their diet. I’d love some more reports: This email address is being protected from spambots. You need JavaScript enabled to view it.)

[966] Gout, red meat and the elimination diet (October 2010)

My husband and I have been doing the elimination diet for two weeks now. We are both feeling great, our tummies are not bloated, we are not sour in the stomach in the morning. Another thing that we are so pleased about! My husband can suffer with gout, if he has any red meat. There are also other triggers for him, but the red meat is really the big one. Over the past weekend, we were at friends, and enjoyed some beef and lamb (only seasoned with salt). I knew that we were pushing the boundaries, but I checked with my husband this morning, and there has been no sign of gout at all! Thank you. Things are really going well. - Carla, NT

FROM [964] My husband is an amine responder and reacts to chocolate with gout like symptoms - Rose, WA

[965] Gout and salicylates (October 2010)

My partner's uncle tells me he used to be addicted to tomato sauce and had to give up because it was causing his bouts of gout.Now he longer gets it unless he goes to Fiji, which he does quite regularly, where he eats a lot of curry (so obviously salicylate related).He had no idea about the connection. Cherie (gout has been associated with low dose salicylates in medication, as shown in a paper available on PubMed)

6. Kjeldsen-Kragh J and others, Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet. 1991;338(8772):899-902. Fasting has been shown to be an effective treatment for rheumatoid arthritis, but most patients relapse on reintroduction of food. In this study fasting was followed by one year of a vegetarian diet and found to be a useful supplement to conventional medical treatment of rheumatoid arthritis.

7. Muller H and others, Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review, Scand J Rheumatol. 2001;30(1):1-10. Clinical experience suggests that fasting followed by vegetarian diet may help patients with rheumatoid arthritis (RA). We reviewed the available scientific evidence, because patients frequently ask for dietary advice, and exclusive pharmacological treatment of RA is often not satisfying ... four controlled studies investigated the effects of fasting and subsequent diets for at least three months. The pooling of these studies showed a statistically and clinically significant beneficial long-term effect. Thus, available evidence suggests that fasting followed by vegetarian diets might be useful in the treatment of RA. http://www.ncbi.nlm.nih.gov/pubmed/11252685

9. RPAH Elimination Diet Handbook with food & shopping guide www.allergy.net.au There is a big gap between reading this book and doing the diet. We recommend supervision by one of our listed dietitians. Dietitians say it takes an hour off consultation time if patients have read my book “Fed Up” before they go.

This observational study looked at more than 40,000 men over 26 years and scored their diets according to DASH and Western dietary patterns. Researchers concluded: "The main components of the DASH diet include fruits, vegetables, nuts and legumes, low fat dairy products, and whole grains, combined with a low intake of sodium, sweetened beverages, and red and processed meats. This pattern substantially overlaps with previous study findings of individual dietary risk factors for hyperuricemia and gout such as meat, seafood, alcohol, fructose-rich beverages, as well as protective (or neutral) factors such as low fat dairy intake, vegetables, legumes, nuts, and plant protein.This explains why the dietary pattern is associated with a lower risk of gout in a dose-responsive manner ... the Western diet is associated with a higher risk of gout." - and see our blog post on gout.

13. McDougall J and others, Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. J Altern Complement Med. 2002;8(1):71-5. Lead researcher Dr John McDougall said “About 70% of people with rheumatoid arthritis (the most common form of inflammatory arthritis) can expect dramatic benefits, and often a cure, in less than 4 weeks of diet change.” http://www.ncbi.nlm.nih.gov/pubmed/11890437

The information given is not intended as medical advice. Always consult with your doctor for underlying illness. Before beginning dietary investigation, consult a dietician with an interest in food intolerance. You can see our list of experienced and supportive dietitians http://fedup.com.au/information/support/dietitians